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Malnourishment and Obesity > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

What are the diagnostic features of anorexia nervosa?

A
  • persistent restriction of energy intake leading to significant low body weight
  • intense fear of gaining weight/behaviour interfering with weight gain
  • disturbance in way one’s body weight/shaped is experienced
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2
Q

What are the subtypes of anorexia nervosa and their symptoms/actions done?

A
  1. Bulimic sub-type
    - bingering
    - vomiting
    - laxative, diuretic abuse
  2. Restrictive sub-type
    - food restriction
    - exercise
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3
Q

What are the diagnostic features of bulimia nervosa?

A
  • recurrent episodes of binge eating characterised by: eating large amounts in discrete time OR lack of control during eating episode
  • recurrent inappropriate compensatory behaviour to prevent weight gain
  • behaviours above occur at least once a week for 3 months
  • self-evaluation is unduly influenced by body shape/weight
  • disturbance not occurring exclusively during episodes of anorexia nervosa
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4
Q

What are the subtypes of anorexia nervosa and their symptoms/actions done?

A
  1. Purging sub-type
    - vomiting
    - laxative, diuretic abuse
  2. Non-purging sub-type
    - food restriction
    - exercise
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5
Q

What is the ratio of females to males, affected by Anorexia nervosa?

A

10:1

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6
Q

What is the community prevalence of AN?

A

0.4 to 100

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7
Q

Which types of people are more AN present in?

A

Dancers, gymnasts, athletes, models

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8
Q

What % of BN present in young females?

A

0.5-1%

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9
Q

Which has an older age onset, AN or BN?

A

BN (bulimia nervosa)

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10
Q

What other eating disorders are there?

A
  1. ARFID (avoidant restrictive food intake disorder) - undereat, but no body image problem
  2. PICA (eating non-nutrients)
  3. OSFED (other specific feeding and eating disorders)
  4. UFED (unspecified eating and eating disorder)
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11
Q

What are some clinical examination abnormalities in bulimia nervosa?

A
  • tooth erosion
  • calluses on knuckles
  • enlarged parotids
  • dehydration
  • irregular pulse
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12
Q

What features tell you that from history, one had BN?

A
  • loss of tooth enamel
  • difficulty swallowing
  • abdominal pain (IBS)
  • gastric dilatation and rupture (rare)
  • bowel disturbance (diarrhea, constipation, piled)
  • absent/irregular menstruation
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13
Q

What are typical features in adults that show history of weight loss?

A
  • loss weight/height
  • amenorrhoea (absence of menstruation)
  • loss sex drive
  • weakness
  • cold tolerance
  • insomnia
  • cyanosis, yellow skin
  • lanugo hair (for insulation)
  • constipation
  • fractures
  • infertility
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14
Q

What are typical features in children/adolescents that show history of weight loss?

A
  • Failure to grow

- Failure to develop

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15
Q

What are some clinical examination abnormalities in bulimia nervosa?

A
  • Emaciation
  • Failure to grow
  • Failure to develop
  • Muscle weakness SUSS test
  • Lanugo hair
  • Dehydration
  • Carotenosis
  • Low blood pressure
  • Slow pulse
  • Low core temperature
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16
Q

In terms of biochemistry, what are some abnormal investigations found in AN?

A
  • Urea usually down
  • Urea, creatinine up if renal - failure or dehydration
  • Sodium down in dehydration or water loading
  • Glucose down
  • potassium down if purging
  • Mg, Phosphate down if refeeding
  • Creatine Kinase (CK) up
  • Liver function tests (Transaminase enzymes up)
  • ECG (Any abnormality, T inversion, Prolonged QTc interval (>450ms))
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17
Q

How do you check bone mineral density thats abnormal in AN?

A
  • using BMD or DEXA scan

- Hip and spine use X-rays

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18
Q

What is ovarian ultrasound used for?

A
  • determine healthy weight
19
Q

What can you tell at diff body weights, from ovarian ultrasound?

A

Low weight: no internal ovarian structure, small follicles

Medium weight: some internal ovarian structure, lots of large follicles (multifollicular phase)

Normal weight: Internal structure with one large dominant follicle diameter 15-22mm

20
Q

At what BMD reading does one conclude that there’s osteopaenia?

A

1-2.5

21
Q

At what BMD reading does one conclude that there’s osteoporosis?

A

<2.5

22
Q

Explain what is hypokalaemia?

A
  • low potassium

- vomiting (loss acid) = alkalosis

23
Q

What can result from hypokalaemia?

A
  • cardiac arrhythmia

- death

24
Q

Why is there slow gut transit time in BN?

A

due to laxative abuse and low potassium

25
Q

What is required when colon is dilated, inactive due to laxative abuse in BN?

A

colostomy

26
Q

If upper GI endoscopy is done on BN patient, what could be shown?

A
  • split oesophageal mucosa due to repeated vomiting, leading to haematemesis
27
Q

What is the Mallory Weiss syndrome?

A

haematemesis from vomiting

28
Q

What are signs of kidney failure in BN?

A
  • raised urea and creatinine

- chronic hypokalaemia and dehydration

29
Q

What percentage of AN recover?

A

47%

30
Q

What percentage of people die with AN?

A

5%

31
Q

What percentage of BN recover?

A

45%

32
Q

What percentage of people die with BN?

A

0.3%

33
Q

What is done to prevent eating disorders?

A
  • programmes
  • expert facilitators
  • programmes inducing cognitive dissonance
34
Q

Name the type of programmes:

A
  1. the Body Project
  2. Sorority Body Image Programme (US)
  3. Student bodies (US)
35
Q

Treatment for AN:

A
  1. Principles of nutritional treatment (resuscitation, repair, repletion)
  2. Refeeding
  3. Family based Therapy (FBT)
  4. Cognitive Behavioural Therapy (CBT-E)
  5. Collaborative caring model (7 workshops)
36
Q

What happens in FBT (family based therapy)?

A
  • seen together or separately
  • effective for patients 21 and under
  • effective without hospitalisation
37
Q

What happens in Cognitive Behavioural Therapy (CBT-E)? Explain the phases:

A

Phase 1: Increasing motivation to change.

Phase 2: If willing, regain weight and tackle eating disorder psychopathology

Phase 3: Helping develop personalized strategies for identifying and correcting any setbacks.
- 40 x 50 min sessions over 40 weeks

38
Q

Treatment for BN:

A
  1. Cognitive Behaviour Therapy (CBT-BN)
  2. Interpersonal Therapy (IPT)
  3. Fluoxetine
39
Q

What is the downside to interpersonal therapy?

A

takes longer time

40
Q

How much fluoxetine is given?

A

60mg

41
Q

Treatment for binge eating disorder:

A
  1. Cognitive Behavioural Therapy (CBT)
  2. Fluoxetine
  3. DBT
42
Q

What is good of CBT and fluoxetine?

A

improves eating and doesn’t lead to weight loss

43
Q

Should bariatric surgeons bother about eating disorder patients?

A

Yes

Malnourishment and Obesity (21 decks)

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